Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0120X | Pediatric Surgery | 028589 | CT |
Y | 2086S0120X | Pediatric Surgery | 093575 | NY |
NPI | 1598861247 |
---|---|
Provider Name | Dr. Peter Selig Liebert |
First Address | White Plains, NY 10604-2906 |
Second Address | White Plains, NY 10604-2906 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2006 |
Last Update Date | 15/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00607570 | (05) | NY |
082589 | CONN. LISCENCE # (01) | CT |
093575 | NEW YORK LISCENCE # (01) | NY |
128591 | (02) | CT |
B15889 | (02) | NY |